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Revision TKR Wberry knee is up<

Will be thinking of you tomorrow and sending up a wish for the best possible solution.
 
Getting ready to get in the car to drive to Kansas City. Giving myself enough time to eat and make sure I am early.
@Kansas Teacher do you mind if I drop your name and who your daughter is, it will maybe boost how the Doctor feels about me. I need all the leverage I can get :-)
 
Well I am here, paperwork all done. The took the disk with xrays and the records, copied them both and returned them. Just sitting in the waiting room. Really nice building, didn't know they did surgeries here also. @Kansas Teacher, was your done here or in a hospital?


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My surgery was there and I really liked the facility. About a 2-1 patient-nurse ratio and very competent staff. Fingers crossed!
 
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Post visit report. Met with Dr. Wingerter in Kansas City today. This is the first time I've been seen by both the nurse the nurse practitioner and the doctor. Of course not all on at the same time but one after the other. The doctor looked at the x-rays and looked at the report and then he started a really good discussion about what he thought the problem was. He also examined the knee and moved it around a lot. I'll start by talking about his discussions concerning the patella. First of all he said that definitely the patella was catching on the implant in the corner of the kneecap and was getting dug out under the bone by the corner of the implant. He then showed me x-rays from another patient that had the exact same implant I have, mentioned that he felt it might be possible the actual shape design of the implant might cause the similar rubbing of the patella whenever someone has kneecaps that pull to the side like mine. The previous patients kneecap actually chipped off on the side where the running started he remove the bone piece did the release and the pain went away for the patient. He recommended doing a similar procedure for me, removing a section of bone because he feels it's probably damaged, and doing a release and realigning everything so that it doesn't rub anymore.

The second area is the knee instability. He agreed that there is definitely instability in the knee. He said that they have to make a tossup between what would happen if they put a larger space and sometimes you may lose range of motion or flexion. So there's a chance that they have to play off which will give them the best advantage of me losing a little bit of range of motion and not being able to straighten the knee all the way to zero or less or getting this ability. He didn't feel that a total replacement of the implant was needed and he'd rather do the minimum thing of the spacer feeling that the current implant will give me much longer life with just a bigger spacer. Also it would increase stability by putting a spacer in there.

He is concerned about the swelling this far out from the surgery and the amount of fluid in the knee. So he gave me a script have a blood test done to check to see if we have infection. If there is infection he said they would need to do a drawing and check in in that case the entire implant would have to come out. He seemed to think that the fluid and swelling was more a result of the problem with the patella rubbing and causing inflammation and a lot of fluid buildup in the knee.

I went ahead and let him know that I was also seeing another physician for a second opinion, but I wanted to make the best choice for the surgery and he seemed very comfortable with that. He also thought it was a good idea to go ahead and get the test that way I can provide the results of the other physician if he needed to see them.

I ask about how soon the surgery can be done he estimated that were looking at probably 4 to 5 weeks out. He is a little light on experience, I felt very comfortable with his bed side manners and approachability. He did give me some decent numbers for surgeries it's just the number of years that he's been doing them. he has been doing high-volume work in this facility here and previously. The number of years of surgeries may not be as high as the other surgeon I have not visited.

His bottom line was to do what works best. If there is no infection and he can get away with both the spacer and fixing the patella, he thinks that will give us the best outcome while conserving the implant and give us the longevity of the implant. He has done both procedures with good success. I need to ask @skigirl about her spacer upsizing and if she had losses in ROM and extension.

@Kansas Teacher your recommendations are on the mark. I feel so comfortable with this OS. He could teach my original OS about bed side manners. I could really tell he cared and wanted to help in anyway he could.




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I'm glad you liked him and felt comfortable with him. Whichever surgeon you end up going with, I know you'll make the right decision and move on with your life. Sounds like he was as thorough as I anticipated he would be when I gave you his name. Now just a couple weeks and you'll see if the other surgeon concurs!

And you know, every time I have seen him, I have seen his nurse, np and then him and one time, they even threw in a resident!!

Roxie
 
So glad to hear you are moving forward!

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Sounds like you got a good bit of information and can now digest it all while waiting for the next appt. I'm a bit relieved for you.
 
Glad you have some answers, and a possible plan. Hope the time passes quickly for your next appointment.
 
Glad to know the first appointment runs good, patience for the second appointment as no need to rush in. Wish best decision will present itself to you soon enough.
 
I read my long post, sorry, I was in my car and basically using "siri" to do voice to text. Thus some grammatical or rambling long sentences. I forgot to say "period" sometimes.

I wanted to point out some interesting comments and ask for some input.
1. The Doctor commented that he has noticed that other patients with the same knee device as mine that have knee caps that tilt out, have the same issue with the patella catching and rubbing. He felt it was more of a shape and form thing with these prosthetic. Has anyone else with the Smith & Nephew had this issue? He even showed me xrays of another patient with the same implant and issue as mine. The solution was to both to remove the section that was binding and release. In the patients case his knee cap has already broken off at the point they impacted. @Josephine, wondering if you have ever heard of this?

2. Spacers go up in size 2mm at a time. Since my clunking seems to be a combination of the patella and the loose implant joint, It should reduce the clunking and remove the catching all together. I understand that there may still be some noise in the end, but my hope it will be nothing like what I am experiencing @skigirl, was this your experience?

3. I am to get a ESR and CRP blood test, will be doing that today. What are they?
 
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